Orthopaedic implants in children: survey results regarding routine removal by the pediatric and nonpediatric...

The role of orthopaedic implant removal in children is controversial. Some children later require adult reconstruction; implant removal may be difficult or may adversely affect the outcome. The purpose of this study is to compare the opinions of the pediatric and nonpediatric specialists regarding routine implant removal in children. Participants were asked to complete a Web-based questionnaire containing demographics, general opinions, and a series of specific case scenarios related to implant removal/retention. The study group consisted of 273 pediatric, and 99 nonpediatric specialists, with an average of 17-year experience. Regarding asymptomatic, stainless steel implants in children, 41% indicated removal most or all of the time, 36% reported sometimes, and the remaining 22% reported almost never or never. Implant location was the only important factor in the decision to remove or retain the implant. A greater percentage of pediatric specialists endorsed implant retention in the hip or pelvis in older children compared with nonpediatric specialists. More experienced surgeons, regardless of specialty area, recommended implant removal. Pediatric specialists may wish to reconsider their preference to retain large hip implants in older children because their nonpediatric colleagues, who presumably are faced with the removal from these children when they reach adulthood, recommend implant removal once they have served their purpose. The number of such cases and the role of early removal in improving the long-term outcome need further study.